Bisphosphonates for Osteoporosis in Nonmetastatic Prostate Cancer Patients Receiving Androgen-deprivation Therapy: A Systematic Review and Meta-analysis

Abstract

This systematic review was conducted to assess the efficacy and safety of bisphosphonates for prevention and treatment of osteopenia or osteoporosis in men with non-metastatic prostate cancer receiving androgendeprivation therapy. We searched for randomised controlled trials (RCTs) of bisphosphonates compared with placebo from Pubmed, Embase, the Cochrane Library, and ISI -Science Citation Index. Meta-analyses of prespecified outcomes (bone mineral density, fractures, and adverse events) were performed using Review Manager. Ten RCTs with a total patient population of 1,017 were identified. There was generally more improvement in bone mineral density of the lumbar spine for patients who received bisphosphonate treatment than placebo or other medical treatment at 12 months (WMD 6.02,95%CI 5.39 to 6.65). Similar effects were also observed for total hip, trochanter or femoral neck bone mineral density. However, there was no significant reduction in fractures. Fever and gastrointestinal symptoms were the most common adverse events (10.4% vs. 1.2%; 0.10% vs. 0.03%). Currently, our meta-analysis suggested that oral and intravenous bisphosphonates caused a rapid increase in spine and hip or femoral BMD in non-metastatic prostate cancer patients receiving androgen-deprivation therapy. Fever and gastrointestinal symptoms were common with the use of bisphosphonates. These short-term trials (maximum of 12 months) did not show fracture reduction. In future, more efficient performance of higher quality, more rigorous, large sample, long-term randomised controlled trials (>12 months) are needed where outcomes are detailed.

Prevalence of and Factors Associated with Osteoporosis among Korean Cancer Survivors: A Cross-Sectional Analysis of the Fourth and Fifth Korea National Health and Nutrition Examination Surveys

“…Risk for osteoporosis is increased in cancer patients, and damage to bone health can be exacerbated by cancer itself as well as treatments such as chemotherapy, radiation, and hormone therapy (Brown and Guise, 2009;Stava et al, 2009;Ding et al, 2013). Such decline in bone density greatly increase the risk of bone fracture and can have other serious effects on the quality of life (Guise, 2006).…”

Abiraterone for Treatment of Metastatic Castration-resistant Prostate Cancer: a Systematic Review and Meta-analysis

“…for men with advanced prostate cancer (Ding et al, 2013;Zhou et al, 2013). Although most men initially respond to castration with treatment of luteinizing hormonereleasing analogues or bilateral orchiectomy, progression eventually occurs, and the median overall survival after chemotherapy is consistently less than 2 years in patients with metastatic castration-resistant prostate cancer (mCRPC) (Crawford et al, 1989).…”

Comparative Efficacy of Bisphosphonates to Prevent Fracture in Men with Osteoporosis: A Systematic Review with Network Meta-Analyses

“…Although cancer-related osteoporosis was not considered in our analysis, as fracture in cancer-associated bone disease may result from causes other than osteoporosis [15], other meta-analyses [40,41] found that zoledronic acid was effective in preventing fractures for patients under androgen deprivation therapy for prostate cancer and nonmetastatic prostate cancer. No other randomized controlled study investigating the efficacy of bisphosphonates in men with osteoporosis was found.…”